Depression Treatment for Urban Low Income Minority Substance Users

城市低收入少数民族药物使用者的抑郁症治疗

基本信息

批准号：
8056795
负责人：
Stacey B Daughters
金额：
$ 32.76万
依托单位：
UNIV OF MARYLAND, COLLEGE PARK
依托单位国家：
美国
项目类别：
财政年份：
2010
资助国家：
美国
起止时间：
2010-04-15 至 2015-03-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/8056795
关键词：
AIDS clinical trial group AIDS prevention Abnormal coordination Abstinence Acquired Immunodeficiency Syndrome Address Adherence Adopted Adverse effects Affect Aftercare Alcohol or Other Drugs use Anti-Retroviral Agents Anus Area Behavior Behavioral Body Weight decreased California Chlamydia Chronic Clinical Clinical Trials Cognitive Complex Contracts Control Groups Data Daughter Depressed mood Development Distal District of Columbia Dose Dropout Drug usage Drug user Educational Background Equipment and supply inventories Event Exhibits Fever Chills Food Frequencies Gastric Emptying Gonorrhea Grant HIV HIV Seropositivity Hand Health Personnel Hepatitis Home environment Impaired cognition Individual Injection of therapeutic agent Intervention Journals Knowledge Life Link Liquid substance Low income Major Depressive Disorder Manuals Measures Mediating Mediator of activation protein Medical Mental Depression Mental Health Minority Modeling Motivation Names Nausea Needle Sharing Needles Nondirective Therapy Numbness Oral Outcome Pain Participant Patient Self-Report Patients Pharmaceutical Preparations Positive Reinforcements Poverty Prevalence Psychiatry Psychological reinforcement Public Health Publishing Questionnaires Randomized Randomized Controlled Trials Recording of previous events Relapse Reporting Research Project Grants Residential Treatment Rewards Risk Risk Behaviors Risk-Taking Sample Size Sampling San Francisco Sex Behavior Sexual Partners Sexually Transmitted Diseases Staging Substance Abuse Treatment Centers Sweat Sweating Symptoms Syringes Testing Time Treatment Efficacy Treatment Protocols United States Substance Abuse and Mental Health Services Administration Universities Vagina Validity and Reliability Work condoms depressive symptoms effective therapy ethnic minority population experience follow-up foot forgetting high risk high risk sexual behavior inner city instrument medication compliance meetings pill primary outcome research and development seal sex sex risk sobriety substance abuse treatment therapy development treatment as usual treatment effect trial comparing urban area

项目摘要

Approximately 22% of substance users suffer from major depression, which is associated with higher rates of substance abuse treatment dropout, relapse to substance use, and HIV risk behavior. Further, in inner-city areas such as DC, rates of substance use and depression disproportionately affect ethnic minorities, as well as those living in poverty. Despite this link, few interventions targeting depression have been developed to meet the specific needs of depressed substance users. One approach that may be especially appropriate in this regard is behavioral activation (BA), which aims to increase individuals¿ engagement in pleasant events, thereby increasing contact with positive reinforcement and decreasing the frequency of aversive events. BA has been shown to be efficacious in the treatment of depression, and this uncomplicated and straightforward approach may be especially appropriate for the specific needs of an inner city low income substance abusing sample. Further, BA compliments standard substance abuse treatment in several key practical and theoretical ways as it is more easily adopted by staff in these settings, more time efficient (e.g., fewer and shorter sessions, group format), more easily understood by patients who suffer from cognitive limitations due to low education level and chronic drug use, and can incorporate aspects of sobriety into its treatment components. In an initial Stage 1 development project, a version of BA, the Life Enhancement Treatment for Substance Use (LETS ACT), was developed and specifically tailored for inner-city low income minority substance users with elevated depressive symptoms. Published in the Journal of Clinical Psychiatry, Daughters et al. (2008) demonstrated that LETS ACT led to a significantly greater reduction in self-reported depressive symptoms and a significant increase in enjoyment and reward value of activities as compared to the TAU control group. While preliminary findings prove promising, many questions remain unanswered and several extensions of this work are necessary, including an assessment of post treatment substance use and HIV risk behavior, a contact-matched control, and a larger sample size to allow for more complex analyses of the mechanisms underlying these outcomes. Thus, the objective of the present proposal is to follow-up on our previous Stage 1 treatment development efforts and small scale randomized control trial (RCT) with a fully-powered Stage 2 RCT comparing LETS ACT to nondirective therapy (NDT) among a sample of 243 low income depressed substance users currently receiving residential substance abuse treatment in inner-city Washington, DC.

大约 22% 的药物滥用者患有重度抑郁症，这与药物滥用治疗中途退出率、药物滥用复发率和艾滋病毒风险行为有关。此外，在华盛顿特区等内城区，药物使用率和抑郁症率也较高。尽管存在这种联系，但针对抑郁症的干预措施却很少被开发出来，以满足抑郁症药物使用者的特定需求，其中一种可能特别合适的方法是行为激活（BA）。，其目的是增加个人??参与愉快的事件，从而增加与积极强化的接触并减少厌恶事件的频率，BA 已被证明在治疗抑郁症方面有效，这种简单而直接的方法可能特别适合内城的特定需求。此外，BA 在几个关键的实践和理论方面补充了标准药物滥用治疗，因为它更容易被这些环境中的工作人员采用，更省时（例如，更少和更短的会议、小组形式）、更容易。被患者理解由于教育水平低和长期吸毒而遭受认知限制的人，可以将清醒的各个方面纳入其治疗组成部分，在最初的第一阶段开发项目中，BA 的一个版本，即物质使用的生命增强治疗 (LETS ACT)。，专为患有抑郁症状的市中心低收入少数物质使用者而开发，Daughters 等人（2008 年）发表在《临床精神病学杂志》上，证明 LETS ACT 可以显着提高抑郁症状。与 TAU 对照组相比，自我报告的抑郁症状减少，活动的乐趣和奖励价值显着增加。治疗药物使用和艾滋病毒风险行为、接触匹配对照和更大的样本量，以便对这些结果的机制进行更复杂的分析。因此，本提案的目标是对我们之前的第一阶段进行后续研究。治疗开发工作和小规模随机对照试验 (RCT) 是一项功能齐全的第 2 阶段随机对照试验，以 243 名目前在华盛顿特区市中心接受住宅药物滥用治疗的低收入抑郁药物使用者为样本，对 LETS ACT 与非指导性疗法 (NDT) 进行了比较。